More Straight Talk for Gay Men about Testosterone Replacement
Several people commented in response to my previous posts about testosterone replacement therapy (TRT). http://www.magneticfire.com/2009/11/19/virility-vitality-and-testosterone/
This one is typical. “I asked my doctor to include a testosterone level along with my other blood work as a part of my physical. It showed my level to be significantly below the bottom end of the normal range. I have been taking AndroGel for about a week. What can I expect?”
I had a similar experience to the above writer when I had my level done, and I was skeptical, but also decided to try AndroGel. Fairly soon after I began, I experienced some changes in sexual desire and function that initially I attributed to a placebo effect. I then began to notice that I was having morning erections, just like the old days, and since I had been sleeping I decided this couldn’t be placebo effect.
Promises about what testosterone replacement can do have been greatly exaggerated: to restore youthful levels of sexual excitement and desire and to create the muscle tone of a teenager, a fountain of youth (metaphorically speaking.)
Aging effects sexual capacity, but the assumptions about how much it is effect are also often greatly exaggerated. When men begin to notice changes, it is often accompanied by a considerable amount of anxiety, and that anxiety interferes further with sexual desire and function. This, in turn, reinforces the feelings of getting old, increasing the anxiety, and a vicious cycle is established.
TRT Delivery Systems:
When a decision has been made for TRT, there are several different ways the testosterone replacement can be administered. The decision depends upon personal preference, side effects and cost:
Injection: Injections are given about every two weeks by a health care provider, a family member, or self-administered. Some report fluctuations in symptom relief between the injections.
Patches: Patches are applied nightly, rotating sites to reduce skin irritation. Some have complained that they come off easily.
Gel: A gel in rubbed onto the skin of the abdomen, chest, arms and shoulders. It takes several hours to absorb so it must be applied after showering.
Buccal: This putty-like substance is applied to the upper gums where it is transformed into a gel which is absorbed.
Costs:
TRT for injection costs between $100-200 per month, plus the cost of the materials. If a health care person administers it, an injection fee is usually added. All of the other preparations can cost between $200-500 per month, and insurance reimbursement varies.
One person has reported that he has his gel prepared by a compounding pharmacy for a cost of less than $100, enough of a cost saving to explore it with your doctor and pharmacy.
Side effects:
The major issues with the injections are related to the inconvenience and fluctuations of therapeutic levels between injections. Patches can cause skin irritation and may be unreliably adherent. The gel is less irritating than the patches but it is possible to transfer the TRT agent to a sexual partner, or even a pet, through skin-skin contact. The Buccal gel may cause irritation of the gums.
Exaggerated claims:
It is important to be aware of the exaggerated claims for feeling sexier, stronger and healthier, but claims about reversing low energy, improving muscle strength and libido have some truth. Some improvement in sexual performance creates a sense of well being and improved mood, and results in an improved attitude that in itself helps contribute to better sexual performance. 
But an entire, costly industry has developed around these treatments that will never be like you were in your prime. Look for improvement, not perfection, especially as defined by advertising promotion.
For me, TRT hasn’t changed the fact that I still need knee and shoulder replacements, and arthritic pains in some of the joints persist, but awakening with morning wood does bring a smile to my face.
I am starting my second year of treatment with testosterone. I had some damage from having untreated diabetes for quite some time. I was quite over-weight. I did not feel healthy, and certainly not very masculine. I had mood swings and depression and my body was different. I was developing breast, losing hair, and had no energy.
After discovering this was the problem, my life changed. After starting testosterone therapy I had more energy and got a personal trainer. My sleep improved and I developed more muscle tone. My voice lowered some, my sex drive improved, I grew more hair and my work-outs improved. I was able to focus better, and I even felt like the size of my penis grew bigger and thicker.
I was told by the doctors that my levels were very low and probably had been like this for longer than five years. They told me some doctors care and take action and start treatment right away. I had changed from my regular physician to a gay doctor, and he told me that most straight doctors don’t care to treat gay men because all they do this for is to have more of a sex drive? Talk about quality of care!
I was a diabetic for four years with no treatment, and my diet sucked. Things really changed in my life. I exercise everyday and hike three times a week. Also my medications where changed for my diabetes. I lost 135 lbs in 8 months. Now, I am no longer on insulin or pills and I don’t need to check my blood sugars three times a day anymore. For me it’s like being the same age I was in high school.
As all of these changes took place my self esteem really improved. Before, being short and heavy and I guess not very handsome to most men, I was never the first one asked to go home from the clubs. I had been posting my personal profiles as a “bear,” a good place to hide the fact you’re out of shape and fat. I still list myself as a bear but now I list and spell “Bear as Behr, ” the “H” for health. Its is also an ice breaker because I am able to talk about my body changing and the improvement in my looks.
I haven’t become vain, just have finally actualized, what most gay men strive for: to be noticed in a crowded room. I try these days to help anyone who needs help, some people I change, and some I don’t.
Testosterone is really nice. It has been a great addition to my health care, and may be helpful to men looking for better health and a longer life.
This man has undergone some dramatic changes in his life, and most likely they are only partially attributable to the testosterone replacement therapy.
As he mentioned, TRT is not just about more sex, but of course, that is usually a good thing, too, and what we find is that when men feel more sexual, they feel more confident in themselves and their self-esteem improves. This then can serve as a motivator for further change.
In this man’s case, his diabetes was certainly an issue for him. By changing his diet and exercise, he successfully lost a significant amount of weight which continued to improve his self-esteem. Haivng more confidence, he became more assertive in his social interactions which contributed to greater response from others.
The importance of this man’s story is that improvement in health must be based on a multi-faceted approach. I have no doubt that the TRT was a factor in his improvement, but his determination to get his life back in control was equally important. When he was able to control his diabetis, he no longer had to take medications which also could have contributed to his earlier difficulty.
As a psychiatrist, I cannot escape commenting on the change of mood. Diet, exercise and improved sleep are essential elements in treating mood disorders, but often it is difficult to motivate people to make these changes. In this man’s case, the TRT may have played an important role in motivating and mobilizing him to make some important changes.
I thank him for his contribution.
Loren Olson
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